tbuckley/cabot-search huggingface dataset:
Clinical Case 13—An unusual culprit: challenging diagnosis, easy solution
Authors: Fernando Guilherme Ribeiro Mané, Rui Flores, Inês Conde, Rodrigo Silva, Carla Marques Pires, Paulo Medeiros, Cátia Oliveira, João Costa, Jorge Marques
Journal: Cardiovascular Research (2022)

Abstract Presentation A 59-year-old woman, with multiple cardiovascular risk factors, a history of CABG (left internal mammary artery—obtuse marginal artery; right internal mammary artery—left anterior descending artery) and PAD; presented to the emergency department with prolonged thoracic pain (3 hours) associated with dyspnea. She was hypertense at admission, but the remaining physical exam was unremarkable. Initial electrocardiogram showed descendent segment ST depression in the lateral leads (DI, aVL and V4-V6). Blood test showed a rise in troponin I 0.6 → 8.3 ng/mL). Cardiac catheterization demonstrated patency of both bypasses. However, a calcified stenosis (70–80%) of the left subclavian artery proximal to the emergence of the left internal mammary artery was observed. Diagnosis The findings suggested a possible coronary subclavian steal syndrome (CSSS). Management The patient was reevaluated and was found to have a systolic blood pressure differential of 18mmHg between the two arms. Despite anti-anginal therapeutic optimization, episodes of angina upon minimal exertion continued. Consequently, she was submitted to percutaneous subclavian artery angioplasty with symptom resolution and was discharged under dual antiplatelet therapy and high-intensity statin. Learning points CSSS complicates 0.2–6.8% of the patients who have undergone CABG with a left internal mammary graft. Peripheral artery disease is its strongest predictor and atherosclerosis is the main pathogenic mechanism. In patients with suspected CSSS, physical examination is paramount, often showing a systolic blood pressure differential. Subclavian artery angiography should be performed, whenever it is relevant, during the coronary angiography. First-line therapy includes percutaneous angioplasty and optimal medical therapy.
Poster No. 134 Zebrafish as a tool to study cardiovascular effects caused by fibrillin impairment
Authors: Julie de Backer, Karo de Rycke, Lisa Caboor, Petra Vermassen, Patrick Sips
Journal: Cardiovascular Research (2022)

Abstract Introduction Marfan syndrome (MFS) is the most common type of fibrillinopathy with a high predisposition to develop TAAD. A thorough understanding of the underlying mechanisms is still lacking, indicating a particular need for more flexible in vivo models to address this knowledge gap. Objectives We aimed to generate a relevant zebrafish model to gain insight into the molecular mechanisms relating fibrillin defects to the cardiovascular system. Methods The CRISPR/Cas9 system was used to systematically target the three different fibrillin genes (fbn1, fbn2a and fbn2b) in Tg(kdrl:GFP) reporter zebrafish. Time-lapse fluorescent microscopy was used to evaluate the cardiovascular phenotype. Results zebrafish lacking fbn1 and/or fbn2a do not show any cardiovascular phenotype during early-stage development. On the other hand, approximately 50% of homozygous fbn2b mutant (fbn2b-/-) zebrafish embryo's show a severe phenotype characterized by endocardial detachment, leading to vascular embolism and premature mortality at 7–9 dpf. Interestingly, the remaining fbn2b-/- zebrafish survive until adulthood, but during larval stages already develop a dilation of the bulbus arteriosus. The caudal vein of all fbn2b-/- embryos also develops abnormally as a cavernous structure lacking vessel integrity. This phenotype is resolved in embryos retaining normal blood flow and aggravated upon pharmacological inhibition of blood flow during development. Conclusion These data indicate that fbn2b-/- zebrafish model recapitulates cardiovascular complications, and can be considered as a relevant model to study the mechanisms underlying MFS pathogenesis. Our preliminary data suggest that there is an interplay between fibrillin deficiency and biomechanical signaling in the regulation of cardiovascular development.
Retracted: Poster No. 014 Diurnal and weekly variation in thrombotic and fibrinolytic status in healthy individuals
Authors: Vassilios P Memtsas, Ying X Gue, Rahim Kanji, Diana A Gorog
Journal: Cardiovascular Research (2022)

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Retracted: Oral Presentation No. 034 A Case Series of patients with Pulmonary Embolism during post COVID-19 period
Authors: Elena Leonidou, Maria Ioannou, Ioanna Chaziri, Angeliki Mouzarou
Journal: Cardiovascular Research (2022)

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Poster No. 020 Increasing transvalvular gradient related to effectiveness of endogenous fibrinolysis in patients with severe aortic stenosis
Authors: Rahim Kanji, Vasileios F Panoulas, Alison Duncan, Simon W Davies, Thomas F Luscher, Saeed S Mirsadraee, Deepa R J Arachchillage, Diana A Gorog
Journal: Cardiovascular Research (2022)

Abstract Background Patients with severe aortic stenosis (AS) are at risk of both bleeding and thrombotic events. The high shear and flow rates across the stenotic aortic valve (AV) degrade von Willebrand factor high molecular weight multimers increasing bleeding risk, but can also lead to platelet activation. The overall effect on thrombotic and endogenous fibrinolytic status remains unclear. We aimed to assess the relationship between AS severity and thrombotic and fibrinolytic profile. Materials and methods In a prospective, observational study, thrombotic and thrombolytic status was assessed in venous blood taken from patients with severe AS using the Global Thrombosis Test. This point-of-care technique measures the time for occlusive thrombus formation under high shear (OT), and the time for spontaneous lysis of the thrombus (LT). We related these parameters to indices of AS severity. Results and conclusions Our cohort comprised of 86 patients (age 79 ± 9 years, 58% male), of whom 25% were on single and 28% on dual antiplatelet medication, 47% on no antithrombotic therapy, and 1% on oral anticoagulation. Lysis time was inversely related to AV peak (r = −0.242, P = 0.04) and mean (r = −0.286, P = 0.012) gradients. The severity of AS, by gradient or valve area, was not related to OT, although OT was inversely related to platelet count (r = −0.248, P = 0.029). Heterogeneity in antithrombotic medications may have masked a relationship between AS severity and OT. We report that increasing severity of AS is related to more effective endogenous fibrinolysis, which may contribute to the increased propensity to bleeding.
Poster No. 098 SGLT2-inhibitors as add-on therapy in cardiac amyloidosis: our experience
Authors: Giovanni Fazio
Journal: Cardiovascular Research (2022)

Abstract Background Cardiac amyloidosis (CA) is a severe and progressive infiltrative disease caused by physiological, inherited or acquired abnormalities, which lead to the accumulation of amyloid fibrils in the cardiac interstitium. Despite recent evidence support the use of SGLT2-inhibitors in heart failure, including HFpEF for empagliflozin and dapagliflozin, there are no studies on the use of these drugs for the treatment of CA. Methods We enrolled 5 consecutive patients with symptomatic CA (II or II NYHA). The diagnosis of was based on non-invasive criteria: echocardiographic criteria + grade 2 or 3 cardiac uptake at diphosponate scintigraphy + negative serum light chains and negative serum and urine immunofixation. Mean age was 66,52 years, all male. Despite optimal therapy, they had symptoms of pulmonary and peripheral congestion. We added 10 mg of dapagliflozin daily to therapy and reassessed patients after 7 days. Results Dapagliflozin was effective as add-on therapy in CA. All treated patients reported an improvement in symptoms and signs. After7 days, dyspnea improved, exercise tolerance evaluated in six minutes walking test increased (from a mean of 123 meters to a mean of212 meters), and oedema decreased. Therapy was well tolerated, and no side effects were reported. Conclusions Our initial experience with dapagliflozin suggests that SGLT2-inhibitors may play a role in the treatment of cardiac amyloidosis. In our opinion, the growing evidence of this class of drugs in heart failure therapy justifies clinical trials on amyloidosis.
Poster No. 031 Anti-inflammatory potential of cannabinoid extracts
Authors: Martin Maly, Jitka Viktorová, Tomáš Ruml, Milena Stránská
Journal: Cardiovascular Research (2022)

Abstract Inflammation plays a substantial role in the process of atherosclerosis. The key players are monocytes transformed to macrophages. Limited experience with anti-inflammatory drugs is described – antibodies for IL-1 (CANTOS) and colchicine (COLCOT, LoDoCo-2 trial). Cannabis extracts are known to have profound anti-inflammatory effect in diseases associated with chronic inflammation, e.g. rheumatoid arthritis. Human monocytic cell line THP-1 was differentiated into macrophages by incubation in the presence of phorbol-12-myristate-13-acetate, which leads to a macrophage-like phenotype characterized by changes in morphology and adhesion. Macrophages were polarized toward M1 pro-inflammatory phenotype responsible for production of several cytokines, esp. TNFα and IL-6.The ability of cannabinoids to decrease production of pro-inflammatory cytokines in polarized macrophages was measured by ELISA. The viability of macrophages after the treatment was verified by resazurin assay., Cannabigerol (CBG) and cannabidiol (CBD) significantly decreased the production of TNFα in dose-dependent manner. 7.5 mg/L of CBG and 1 mg/L of CBD decreased the production of TNFα by 32 and 34%, respectively. CBD, cannabidivarin (CBDV), cannabichromene (CBC), and cannabinol (CBN) significantly decreased also IL-6 production. 7.5 mg/L of CBDV and CBC decreased the production of IL-6 by 38 and 62%, respectively. 2 mg/L of CBD and CBN decreased the production of IL-6 by 33% (both).The concentration of the most potent cannabinoid (CBC) inhibiting IL-6 production by half (IC50) was determined to be 6.7 ± 0.1 mg/L, which is two-times better treatment potential than colchicine (13.4 ± 0.8 mg/L). Cannabinoids might be promising substance in the treatment of subclinical inflammation associated with atherosclerosis. The project was funded by the Grant No 22–20860S of The Czech Science Foundation.
Oral Presentation No. 41 High plasma von Willebrand factor concentration is associated with the development of bleeding complications in patients with polyvascular disease receiving multicomponent antithrombotic therapy
Authors: E Krivosheeva, A Komarov, A Dobrovolsky, V Korobkova, E Titaeva, M Tripoten, T Balakhonova, E Panchenko
Journal: Cardiovascular Research (2022)

Abstract Background von Willebrand factor (VWF) is well known biochemical marker of endothelial dysfunction that increased may be associated with the development of thrombotic complications in patients with polyvascular disease (PD). We aimed to asses the relation of VWF to the development of bleeding outcomes in patients with PD receiving multicomponent antithrombotic therapy (MAT). Material and methods The data were obtained during the prospective register REGATA-1, NCT04347200. 95 patients (70 males), median age 67 [IQR 61; 72] with PD (coronary artery disease and peripheral atherosclerosis of at least one vascular territory ≥ 50%) were enrolled. 61% of patients received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid, other (39%)with clopidogrel. Median follow-up was 10 months [IQR 8.0; 12.0]. The safety end point was major and clinically relevant bleedings (type 2–5) according to the BARC classification. Plasma samples for VWF were taken at the inclusion and analyzed using ELISA. Results Frequency of BARC 2–5 bleedings was 20%. The most frequent (79%) was gastrointestinal bleedings. Median VWF plasma concentration was 154% [116; 196]. According to the quartile analysis, VWF values in the top three quartiles distribution (cut-off value &amp;gt; 122%) were associated with a higher frequency of bleeding events: 3.7% versus 36.7%, OR 8.8; CI 1,11-69,9, ? = 0.0392. Bleeding-free survival in groups formed depending on the VFW plasma concentration (122 &amp;gt; and ≤ 122%) was 96.2% vs. 73.9%, respectively, Log-Rank P = 0.0488. Conclusions Increase of VWF plasma concentration (&amp;gt; 122%) is associated with the development of major and clinically relevant bleedings in patients with PD receiving MAT.
Clinical Case 20—Recurrent intracoronary in-stent restenosis in a young woman
Authors: Margarida Cabral, Mariana Carvalho, Sara Fernandes, Rita Carvalho, Tiago Teixeira, Catarina Ruivo, Pedro Jerónimo de Sousa, Alexandre Antunes, João Morais
Journal: Cardiovascular Research (2022)

Abstract Clinical case A 39-year-old smoker woman underwent a percutaneous coronary intervention with two Zotarolimus-eluting stents implantation due to right coronary artery occlusion in the context of ST-elevation myocardial infarction (MI). She was medicated with dual antiplatelet therapy and high-intensity statin and stopped smoking. Nine months later, due to angina symptoms, cardiac catheterization with intravascular ultrasound showed severe restenosis, treated with a drug-coated balloon (DCB). Two months later, she was admitted due to non-ST elevation MI and the cardiac catheterization presented thrombotic occlusion of previously implanted stents, treated with balloon dilatation. After two months, she remained with angina and a dobutamine stress echocardiogram showed inferior wall ischemia. The angiographic revision revealed proximal in-stent restenosis, treated with DCB. About a year later, a fifth coronary angiography was performed due to recurrence of angina. Diffuse in-stent restenosis by neo-atherosclerosis was identified by optical coherence tomography. The lesion was treated with a cutting balloon and Everolimus-eluting stent implantation. The cholesterol-lowering treatment was optimized and the patient remained stable for some months. However, she is currently reporting recurrence of angina. Clinical management and guidance await Heart Team discussion. Learning points
Clinical Case 12—Thrombus on apical left ventricle: when the clinical suspicion is high
Authors: Fabiana Silva Duarte, Inês Coutinho dos Santos, Maria Inês Barradas, Luís Oliveira, Carina Machado, Raquel Dourado, Dinis Martins
Journal: Cardiovascular Research (2022)

Abstract Introduction Left ventricular thrombi may develop as a complication of myocardial infarction. Transthoracic echocardiography (TTE) has a low sensitivity for thrombus detection and other imaging methods are usually required. Case report A 32-years-old man with a past medical history of smoking habits, obesity and a ST-segment elevation myocardial infarction (STEMI) diagnosed on December 2017. Primary angioplasty was performed with stent implantation in the anterior descending coronary artery. TTE revealed severe systolic dysfunction (SD) and an apical aneurysm with thrombus formation. Six months after anticoagulation with warfarin, a cardiac magnetic resonance revealed thrombus resolution and it was decided to stop warfarin. On September 2021, the patient presented to the Emergency Department referring sudden chest pain. The electrocardiogram showed an anterior STEMI and in the Cath Lab a late stent thrombosis was evident. TTE revealed a severe SD and akinesia of apical segments (poor acoustic window). On the 3rd day of hospital stay, the patient developed backache and Murphy´s punch sign. Imaging workup was suggestive of right renal infarction. At this time, the suspicion of embolic source arises, and the patient underwent contrast echocardiography demonstrating a filling defect suggestive of an apical thrombus. Therapy with warfin was reinitiated concomitantly with dual antiplatelet therapy. Conclusion This is a particular case of an apical thrombus formation occurring twice in a young patient. There is a lack of evidence about the adequate screening methods and therapeutic approach. More cases need to be reported to understand the best approach in each case to minimize complications.
Poster No. 072 The profile of rhythm disorders in women with ischemic heart disease in a Romanian hospital
Authors: Irimie Diana Andrada, Zdrenghea Dumitru, Fringu Florina, Popescu Mircea Ioachim, Pop Dana
Journal: Cardiovascular Research (2022)

Abstract Background In Europe, the mortality secundary to ischemic heart disease is an important cause of death among women. Rhythm disorders are frequently encountered in the context of this pathology. The aim of the study is to evaluate the profile of rhythm disorders in women with microvascular and obstructive coronary heart disease. Materials and methods We included in the study a number of 150 patients with ischemic heart disease documented by coronary angiography, with an average age of 63.24 ± 10.09 years, admited in the Cardiology Department of the Clinical Rehabilitation Hospital, Cluj-Napoca, Romania. The diagnosis of ischemic heart disease was established according to the recommendations of the 2019 ESC guideline. Results 66.6% of patients presented with microvascular angina, and 33.33% with obstructive coronary heart disease. Women with microvascular angina were younger (61.07 ± 9.68 vs. 67.60 ± 9.55 years). Atrial arrhythmias were the most frequent arrhythmias diagnosed - 64.66%. The percentage of rhythm disorders was similar in the two groups, without statistically significant differences: atrial fibrillation (21 vs. 22%), other supraventricular arrhythmias (39 vs. 52%), ventricular extrasystoles (42 vs. 44%), sustained/nonsustained ventricular tachycardia (4 vs. 4%). This finding shows us that not only obstructive coronary artery disease, but also microvascular angina presents an arrhythmogenic risk. At the same time, there were no significant differences regarding the administration of antiarrhythmics, namely amiodarone and betablockers in the two forms of ischemic heart disease. Conclusions Women with microvascular angina present significant arrhythmias, therefore they must be carefully evaluated and treated accordingly.
Poster No. 050 Klotho protein supports mechanical function and prevents MMP-mediated injury of heart during ischemia/reperfusion
Authors: Agnieszka Olejnik, Anna Krzywonos-Zawadzka, Marta Banaszkiewicz, Iwona Bil-Lula
Journal: Cardiovascular Research (2022)

Abstract Background The injury of the myocardium during ischemia/reperfusion (IRI) involves metabolic, morphological, and contractile disorders. Klotho is a membrane or soluble anti-aging protein. Recent studies have proven the correlation between Klotho deficiency and the occurrence and development of cardiovascular diseases. The study aimed to evaluate the effect of Klotho protein on hearts subjected to IRI. Material and methods Isolated Wistar rat hearts perfused with the Langendorff method were subjected to ischemia, followed by reperfusion, in the presence or absence of Klotho protein. Hemodynamic parameters and the levels of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-Κb), nitrate/nitrite, inducible nitric oxide synthase (iNOS), asymmetric dimethylarginine (ADMA), matrix metalloproteinase 2 (MMP-2), MMP-9 and tissue inhibitor of MMP type 4 (TIMP-4) were evaluated. Results Infusion supply of Klotho during IRI resulted in the recovery of contractile function (P = 0.031) and heart rate (P = 0.02). IRI activated MMP-2 (P = 0.042) and MMP-9 (P = 0.041) in hearts, as compared to aerobic control. Klotho contributed to increase in iNOS level (P = 0.02), and decreased levels of NF-Κb (P = 0.006), ADMA (P = 0.007), nitrate/nitrite (P = 0.022), MMP-2 (P = 0.024) and MMP-9 (P &amp;lt; 0.001), as compared to IRI group. Conclusions Klotho protein preserved heart mechanical function and reduced the level of proteolytic enzymes in the heart. Thus, Klotho can be recognized as a novel cardiopreventive/cardioprotective agent in ischemic damage. This work was supported by the National Science Centre, Poland [grant number 2019/33/N/NZ3/01649].
Oral Presentation No. 090 Pleiotropic effect of antiplatelet ticagrelor: expression of CYP4F2 in HUVEC and HepG2
Authors: Ieva Ciapiene, Ugne Meskauskaite, Silvija Andruskeviciute, Vaiva Lesauskaite, Vacis Tatarunas
Journal: Cardiovascular Research (2022)

Abstract Background Ticagrelor is a first drug of a new chemical class cyclopentyltriazolopyrimidines and a third-generation P2Y12 inhibitor that targets and directly binds platelet P2Y12 receptors. It is recommended to be given as a dual antiplatelet therapy (DAPT) with aspirin for the prevention of thrombotic events and the following ischemic heart disease. Ticagrelor is also known to have pleiotropic effects of unknown mechanisms. It is questioned whether ticagrelor could influence the expression of cytochrome P450 4F2 (CYP4F2) enzyme involved in the resolution of inflammation and biosynthesis of pro-inflammatory eicosanoids. This study aimed to investigate if ticagrelor could alter the expression of CYP4F2 and its encoded protein concentration in both endothelial cells (human umbilical vein endothelial cells, HUVEC) and the metabolism of various xenobiotics performing, CYPs-rich liver cells (HepG2). Material and methods The expression of CYP4F2 was determined in HUVEC and HepG2 cell lines by qPCR on real time thermal cycler ABI 7900HT (Applied Biosystems, USA). CYP4F2 protein concentration was determined with sandwich enzyme immunoassay kit for CYP4F2 (Cloud-Clone Corp., USA). Results and conclusions Ticagrelor was observed to reduce the expression of CYP4F2 in HUVEC and HepG2 cell lines. It also reduced CYP4F2 protein levels in HUVEC cells. Thus, ticagrelor may have a protective role in endothelial cells and reduce vascular inflammation. Funding sources This work was supported by the Research Council of Lithuania under Grant 09.3.3.-LMT-K-712-16-0187.
Clinical Case 29—The role of transthoracic echocardiography on patients presenting with shock of unknown etiology
Authors: Sofia B Paula, Margarida Figueiredo, Mariana Santos, Hélder Santos, Samuel Almeida
Journal: Cardiovascular Research (2022)

Abstract Seventy-six-year-old woman, with a previous medical history of arterial hypertension, dyslipidaemia, hypothyroidism and mitral valve plasty (previous rheumatic fever) presents to the emergency department with unspecific complaints of malaise, productive cough and dyspnoea for the past 15 days. At admission, the patient was conscient, apyretic, tachycardic, hypotensive and with peripheric oxygen saturation of 90% (on room air). The patient became haemodynamically unstable and unresponsive. Electrocardiogram with sinus tachycardia, SIQIII pattern and a slight ST elevation in aVR and ST depression in DI, aVL and precordial leads. TTE revealed right cavities dilatation and the presence of a serpiginous echogenic mass that protruded from the inferior vena cava crossing the right atrium and reaching the right ventricle. Thrombolysis, fluid challenge and vasopressor perfusion were immediately started with a good clinic response. Haemodynamic stability was achieved 5 hours after the thrombolysis. An unfractionated heparin perfusion was initiated after the thrombolysis and discontinued 24 h after the patient was admitted. The remaining hospitalization was uneventful and the patient was discharged 7 days after on a non-vitamin K antagonist oral anticoagulant. TTE revaluation before discharge revealed mild dilatation of the right cavities with mild systolic dysfunction of the right ventricle and a normal PSAP. There is no scientific evidence regarding the best strategy to approach a patient with a migrating thrombus and TTE is of high value in the case of shock due to its high specificity as a rule-in test, especially when the patient cannot undergo other types of exams. Figure 1Transthoracic echocardiography (subcostal 4 chamber view) showing the presence of a serpiginous echogenic mass in the right atrium (red arrow).